Translation and trans-cultural adaptation to the Malay version of the COVID-19 vaccine hesitancy questionnaire among healthcare workers in Malaysia.

INTRODUCTION: Healthcare workers play a crucial role in supporting COVID-19 vaccination as they are the most trusted source of information to the public population. Assessing the healthcare workers' hesitancy towards COVID-19 vaccination is pertinent, however, there are limited validated tools to measure their hesitancy on COVID-19 vaccines. This study aims to adapt and validate the first COVID-19 hesitancy scale among healthcare workers in Malaysia. MATERIALS AND METHODS: This study adapted and translated the Vaccine Hesitancy Scale (VHS) developed by the WHO SAGE Working Group. The scale underwent a sequential validation process, including back-back translation, content, face, and construct validity for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The reliability was tested using internal consistency (Cronbach's alpha composite reliability (CR) and average variance extracted (AVE)). RESULTS: The data for EFA and CFA were completed by a separate sample of 125 and 300 HCWs, respectively. The EFA analysis of the C19-VHS-M scale was unidimensional with 10 items. A further CFA analysis revealed a uniform set of nine items with acceptable goodness fit indices (comparative fit index = 0.997, Tucker-Lewis index = 0.995, incremental fit index = 0.997, chi-squared/degree of freedom = 1.352, and root mean square error of approximation = 0.034). The Cronbach's alpha, CR and AVE results were 0.953, 0.95 and 0.70, respectively. CONCLUSIONS: The questionnaire was valid and reliable for use in the Malay language.

Validation of the questionnaire "Pregnancy Vaccine Hesitancy Scale (pVHS)" toward COVID-19 vaccine for Malaysian pregnant women.

Background: Pregnancy is one of the risks for severe COVID-19 infection, and receiving a vaccination is one of the effective methods to reduce disease severity. However, COVID-19 vaccine hesitancy among pregnant women remains an issue. This study aims to develop and validate the pregnancy Vaccine Hesitancy Scale (pVHS) toward COVID-19 vaccine for Malaysian pregnant women. Method: An 8-item Malay language pregnancy Vaccine Hesitancy Scale (pVHS-M) for COVID-19 was adapted from the adult Vaccine Hesitancy Scale and validated using Exploratory Factor Analysis. Six expert panels were involved in content validity, and ten pregnant women were involved in face validity. A cross-sectional study on 200 pregnant women was conducted between October 2022 and March 2023 at the Obstetrics and Gynaecology Clinic, Universiti Sains Malaysia, Kelantan. Result: The item-level content validity index is 1.00, demonstrating good relevance of the eight items used to assess COVID-19 vaccine hesitancy. The item-level face validity index obtained is 0.99, indicating that the items were clear and comprehensible. The Cronbach alpha score was 0.944, with factor loadings ranging from 0.79 to 0.89. Conclusion: The pVHS-M demonstrated good internal consistency, indicating that it is a valid and reliable tool for assessing COVID-19 vaccine hesitancy among pregnant women.

Nursing lecturers' perception toward E-learning approaches used in nursing colleges: Scoping review.

BACKGROUND: Nursing colleges have traditionally taught students in hospitals and laboratories. COVID-19 compelled most nursing colleges to embrace e-learning without prior experience or preparation after 2020, which may influence nursing educators' views and attitudes toward its use. OBJECTIVE: This scoping review explores the nursing educators' perception of the e-learning approaches used in nursing colleges. DESIGN: A comprehensive review of five databases, Cochrane, Ebsco (Medline), PubMed, Science Direct, and Scopus, was conducted, adhering to the Joanna Brings Institute (JBI) standards full theme, utilizing preset eligibility criteria and adhering to the PRISMA Extension for Scoping review (PRISMA-ScR) recommendations. METHODS: This scoping review examined studies published in English from January 1st, 2017-2022. Three reviewers evaluated the eligibility of the literature and retrieved data to address the research question from prior literature. A content analysis was done. RESULTS: Thirteen articles with various hypotheses and models were reviewed. The review reveals that nursing educators are novices at using e-learning approaches in their classes due to their novelty in most nursing colleges. Nursing educators have a modest positive perception, with an optimistic perspective on e-learning effectiveness in theoretical course teaching, emphasizing that it is inappropriate in teaching clinical courses. The review demonstrates that e-learning faces numerous challenges that negatively impact educators' perceptions. CONCLUSION: Institutional preparedness in terms of personnel through educator training, provision of necessary infrastructure, administrative support, and incentives are critical to improving the perception of the e-learning method and increasing its adoption in nursing colleges.

Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis.

Background: Polycystic ovary syndrome (PCOS) is a disorder in reproductive age women and is characterized by hyperandrogenic anovulation and oligo-amenorrhea, which leads to infertility. Anovulation in PCOS is associated with low follicle-stimulating hormone levels and the arrest of antral follicle development in the final stages of maturation. L-carnitine (LC) plays a role in fatty acid metabolism, which is found to be lacking in PCOS patients. This systematic review and meta-analysis aimed to determine the effectiveness of LC supplementation for patients with PCOS. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information Database (PsycINFO), and the World Health Organization International Clinical Trials Registry Platform for all randomized control trials, comparing LC alone or in combination with other standard treatments for the treatment of PCOS from inception till June 2021. We independently screened titles and abstracts to identify available trials, and complete texts of the trials were checked for eligibility. Data on the methods, interventions, outcomes, and risk of bias from the included trials were independently extracted by the authors. The estimation of risk ratios and mean differences with a 95 percent confidence interval (CI) was performed using a random-effects model. Results: Nine studies with 995 participants were included in this review. Five comparison groups were involved. In one comparison group, LC reduced the fasting plasma glucose (FPG) (mean differences (MD) -5.10, 95% CI [-6.25 to -3.95]; P = 0.00001), serum low-density lipoprotein (LDL) (MD -25.00, 95% CI [-27.93 to -22.07]; P = 0.00001), serum total cholesterol (MD -21.00, 95% CI [-24.14 to -17.86]; P = 0.00001), and serum triglyceride (TG) (MD -9.00, 95% CI [-11.46 to -6.54]; P = 0.00001) with moderate certainty of evidence. Another comparison group demonstrated that LC lowers the LDL (MD -12.00, 95% CI [-15.80 to -8.20]; P = 0.00001), serum total cholesterol (MD -24.00, 95% CI [-27.61 to -20.39]; P = 0.00001), and serum TG (MD -19.00, 95% CI [-22.79 to -15.21]; P = 0.00001) with moderate certainty of evidence. Conclusion: There was low to moderate certainty of evidence that LC improves Body Mass Index (BMI) and serum LDL, TG, and total cholesterol levels in women with PCOS.

Knowledge and Attitude on Childhood Vaccination among Healthcare Workers in Hospital Universiti Sains Malaysia.

(1) Background: Vaccine hesitancy is recognized as an important issue globally and healthcare workers (HCWs) have a powerful influence on the public. Recent studies have reported that there are increasing numbers of vaccine hesitancies among HCWs. This study was conducted to assess the knowledge and attitudes on childhood vaccinations among HCWs in Hospital Universiti Sains Malaysia (HUSM). (2) Methods: This is a cross-sectional study conducted among one hundred and ninety-eight HCWs in HUSM, Kubang Kerian, Kelantan who were selected via convenient sampling. Data on their socio-demographic details, working experience, and main source of information regarding childhood vaccination were collected. A validated, Malay version of the knowledge and attitude on childhood vaccination (KACV) questionnaire was used during the study. (3) Results: Female (OR (95% CI):3.15, (1.39, 7.12), p < 0.05) and a higher education level (degree and above) (OR (95% CI): 2.36 (1.14, 4.89), p < 0.05) are significantly associated with good knowledge. Respondents with a history of side effects of the vaccines among their relatives were about 66% less likely to have good knowledge (OR (95% CI): 0.342 (0.16, 0.73), p < 0.05). A positive attitude towards childhood vaccination was significantly associated with a higher level of education participants, who had significantly better knowledge than participants with a lower education level (OR (95% CI): 3.81, (1.92, 7.57), p < 0.001). On the contrary, participants having direct contact with patients were less likely to have a good attitude towards childhood vaccination (OR (95% CI): 0.207 (0.043, 0.10), p < 0.05), and those with a history of severe side effects of the vaccines among their relatives were also significantly associated with a poor attitude towards childhood vaccination (OR (95% CI: 0.342 (0.16, 0.76), p < 0.05).; (4) Conclusions: The survey findings showed a good level of knowledge and a good attitude of participants towards childhood vaccination. Good knowledge is important for the HCWs to have a favourable attitude to educate the general population on childhood vaccination.

Prevalence, Symptoms, and Associated Factors of Chronic Constipation Among Older Adults in North-East of Peninsular Malaysia.

This study aimed to determine the prevalence, symptoms, and associated factors of chronic constipation among older adults in the North-East of Peninsular Malaysia. A cross-sectional study was conducted among older patients from four health clinics. A total of 400 older patients participated, with a mean age of 68.7 (SD = 6.4) years. The prevalence of chronic constipation was 14.8%. The highest symptom reported was the inability to pass stool (98.3%). Chronic constipation was significantly associated with older age (OR = 2.97; 95% CI [1.17, 7.54]; p = .022), inadequate plain water intake per day (OR = 2.13; 95% CI [1.13, 4.02]; p = .020), hypertension (OR = 2.22; 95% CI [1.07, 4.61]; p = .033), and hyperlipidemia (OR = 2.52; 95% CI [1.24, 5.11]; p = .010). Identification of chronic constipation should be done as part of routine clinic visits, especially for older patients with cardiovascular disease.

Development and validation of the knowledge and attitude regarding childhood vaccination (KACV) questionnaire among healthcare workers: the Malay version.

Health care workers play an important role in supporting childhood vaccination as they are the most trusted source of vaccine-related information for parents. However, there is limited validated tools to measure their knowledge and attitude on childhood vaccination. This study aims to develop and validate knowledge and attitude regarding childhood vaccination (KACV) questionnaire among healthcare workers. The questionnaire was developed based on literature reviews and underwent a sequential validation process, including content, face validity and exploratory factor analysis. However, the attitude section is unidimensional and has undergone reliability analysis only. The preliminary knowledge questionnaire contains 33 items and the attitude questionnaire consists of 17 items. The preliminary KACV showed a high item Content Validity Index and Face Validity Index. The final questionnaire consists of 10 items for knowledge and 15 items for attitude. The Cronbach alpha for the knowledge and attitude section were 0.896 and 0.861, respectively. KACV is a valid and reliable tool to measure healthcare workers' knowledge and attitude on childhood vaccination.

Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors.

Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.

Psychometric evaluation of a newly developed Elderly-Constipation Impact Scale.

BACKGROUND: Chronic constipation is a common symptom among the elderly, and it may affect their quality of life (QoL). A lack of available research focused on the elderly means that this effect is not well understood. This study aimed to develop and validate a new scale (Elderly-Constipation Impact Scale (E-CIS)) to measure the impact of chronic constipation on QoL among the elderly. METHODS: A pool of items was generated from a qualitative study, literature reviews, and expert reviews. Exploratory factor analysis (EFA) was performed on the original 40 items of the E-CIS and followed by 27 items for confirmatory factor analysis (CFA). A total of 470 elderly people with chronic constipation were involved. RESULTS: The mean age of the participants was 68.64 ± 6.57. Finally, only 22 items were indicated as appropriately representing the E-CIS, which were grouped into seven subscales: 'daily activities', 'treatment satisfaction', 'lack of control of bodily function', 'diet restriction', 'symptom intensity', 'anxiety' and 'preventive actions'. The scale was confirmed as valid (root mean square error of approximation (RMSEA) = 0.04, comparative fit index (CFI) = 0.961, Tucker-Lewis index (TLI) = 0.952 and chi-square/degree of freedom (chiSq/df) = 1.44) and reliable (Cronbach's alpha: 0.66-0.85, composite reliability (CR) = 0.699-0.851) to assess the impact of chronic constipation on the elderly's QoL. CONCLUSIONS: The E-CIS is useful to measure the impact of chronic constipation on the elderly's QoL. A further test is needed to determine the validity and reliability of this scale in other elderly population.

Evaluation of Chondroprotective Activity of Channa striatus in Rabbit Osteoarthritis Model.

OBJECTIVES: The objective of the study is to evaluate the chondroprotective activity of Channa striatus (Channa) and glucosamine sulphate (glucosamine) on histomorphometric examinations, serum biomarker, and inflammatory mediators in experimental osteoarthritis (OA) rabbit model. DESIGN: Anterior cruciate ligament transection (ACLT) was performed to induce OA in thirty-three male New Zealand white rabbits and were randomly divided into three groups: Channa, glucosamine, and control group. The control group received drinking water and the Channa and glucosamine groups were orally administered with 51.4 mg/kg of Channa extract and 77.5 mg/kg of glucosamine sulphate in drinking water, respectively, for eight weeks and then sacrificed. The articular cartilage was evaluated macroscopically and histologically using semiquantitative and quantitative methods. Serum cartilage oligomeric matric protein (COMP), cyclooxygenase 2 (COX-2) enzyme, and prostaglandin E2 (PGE2) were also determined. RESULTS: Macroscopic analysis revealed that Channa group have a significantly lower severity grade of total macroscopic score compared to the control (p < 0.001) and glucosamine (p < 0.05) groups. Semiquantitative histology scoring showed that both Channa and glucosamine groups had lower severity grading of total histology score compared to the control group (p < 0.001). In comparison with the control, Channa group had lower histopathological changes in three compartments of the joint compared to glucosamine group which had lower histological scoring in two compartments only. The cartilage thickness, area, and roughness of both Channa (p < 0.05) and glucosamine (p < 0.05) groups were superior compared to the control group. However, the Channa group demonstrated significantly less cartilage roughness compared to the glucosamine group (p < 0.05). Serum COMP levels were lower in both Channa (p < 0.05) and glucosamine (p < 0.05) groups compared to the control group. CONCLUSION: Both oral administration of Channa extract and glucosamine exhibited chondroprotective action on an ACLT OA-induced rabbit model. However, Channa was superior to glucosamine in maintaining the structure of the cartilage.

Long-term effects of honey on cardiovascular parameters and anthropometric measurements of postmenopausal women.

OBJECTIVE: To investigate the long-term effects of Tualang Honey versus Honey Cocktail (mixture of honey, bee bread, and royal jelly) on cardiovascular markers and anthropometric measurements of postmenopausal women. METHODS: We conducted a randomised, double blinded, two-armed parallel study comparing 20 g/day of Tualang Honey versus 20 g/day Honey Cocktail among postmenopausal women aged 45-65 years. The cardiovascular parameters and anthropometrics measurements were assessed at baseline, 6 months, and 12 months of the intervention. RESULTS: 100 subjects were successfully randomised into the groups. There was a significant decrease in the diastolic blood pressure from 77.92 mmHg at baseline to 73.45 mmHg at 12 months (F-statistic = 2.55, p-value = 0.047) in the Tualang Honey group compared to Honey Cocktail. There was also a significant decrease in the fasting blood sugar from 6.11 mmol/L at baseline to 5.71 mmol/L at 12 months (F-statistic = 4.03, p-value = 0.021) in the Tualang Honey group compared to the Honey Cocktail group. The body mass index remained unchanged at 27 kg/m2 (F-statistic = 1.60, p-value = 0.010) throughout 12 months of the intervention in the Honey Cocktail group. CONCLUSION: Subjects who received Honey Cocktail showed remarkable effects on body mass index. However, Tualang Honey supplementation showed superior effect in lowering diastolic blood pressure and fasting blood sugar compared to Honey Cocktail. Further studies are required to ascertain the underlying mechanism(s) of Tualang Honey and Honey Cocktail on each observed parameter.

The effects of Momordica charantia (bitter melon) supplementation in patients with primary knee osteoarthritis: A single-blinded, randomized controlled trial.

BACKGROUND: Osteoarthritis is a common problem affecting the joints in the elderly, caused disability and consequently decrease the quality of life. The conservative treatment includes the usage of analgesia, but the use of herbal medicine is growing. Momordica charantia or bitter melon has been widely described to have anti-diabetic and anti-inflammatory effects. However, its effect on reducing pain in primary knee osteoarthritis is not well studied. We aim to determine the effects of Momordica charantia in reducing pain among primary knee osteoarthritis patients. MATERIALS AND METHODS: Thirty-eight and thirty-seven primary knee osteoarthritis patients underwent 3 months of Momordica charantia and placebo supplementation respectively. Three 500 mg per capsule of Momordica charantia were taken thrice daily. Rescue analgesia was allowed as needed. Pain and symptoms throughout the Momordica charantia supplementation period were assessed using Knee Injury and Osteoarthritis Outcome Score and EQ-5D-3L Health questionnaire, while rescue analgesia intake throughout the period of supplementation was measured using analgesic score. RESULTS: After 3 months supplementation period, body weight, body mass index, and fasting blood glucose reduced significantly in the Momordica charantia group. There were also significant improvements in Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, and reduction in analgesic score. The placebo group had also shown significant improvements in certain Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, but with increased of the analgesic score. CONCLUSION: Momordica charantia supplementation offers a safe alternative to reducing pain and improving symptoms among the primary knee osteoarthritis patients while reducing the need for analgesia consumption. These beneficial effects can be seen as early as 3 months of supplementation.

Adaptation and Validation of the Malay Version of the Osteoarthritis Knee and Hip Quality of Life Questionnaire among Knee Osteoarthritis Patients.

OBJECTIVE: To adapt and validate the Malay version of Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire. DESIGN: The OAKHQOL was adapted into Malay version using forward-backward translation methodology. It was then validated in a cross-sectional study of 191 patients with knee osteoarthritis (OA). Patients completed the OAKHQOL and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Confirmatory analysis, reliability analysis, and Pearson correlation test were performed. RESULTS: The new five-factor model of 28 items demonstrated an acceptable level of goodness of fit (comparative fit index = 0.915, Tucker-Lewis index = 0.905, incremental fit index = 0.916, chi-squared/degree of freedom = 1.953, and root mean square error of approximation = 0.071), signifying a fit model. The Cronbach's alpha value and the composite reliability of each construct ranged from 0.865 to 0.933 and 0.819 to 0.921, respectively. The Pearson correlation coefficient between the OAKHQOL and the WOMAC showed adequate criterion validity. Known groups validity showed statistical difference in body mass index in physical activity, mental health, and pain construct. The pain domain was statistically different between the age groups. CONCLUSION: The Malay version OAKHQOL questionnaire is a valid and reliable instrument to assess health-related quality of life in knee OA patients.

Randomized Controlled Trial on the Effect of Channa striatus Extract on Measurement of the Uterus, Pulsatility Index, Resistive Index of Uterine Artery and Superficial Skin Wound Artery in Post Lower Segment Caesarean Section Women.

AIM: To compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo. BACKGROUND: Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain. METHODOLOGY: This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively. RESULTS: Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively). CONCLUSION: Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS. TRIAL REGISTRATION: www.isrctn.com 11960786.

The Effect of Channa striatus (Haruan) Extract on Pain and Wound Healing of Post-Lower Segment Caesarean Section Women.

Channa striatus has been consumed for decades as a remedy to promote wound healing by women during postpartum period. The objectives of this study were to compare postoperative pain, wound healing based on wound evaluation scale (WES), wound cosmetic appearance based on visual analogue scale (VAS) scores and patient satisfaction score (PSS), and safety profiles between C. striatus group and placebo group after six weeks of lower segment caesarean section (LSCS) delivery. A randomised, double-blind, placebo-controlled study was conducted. Subjects were randomised in a ratio of 1 : 1 into either the C. striatus group (500 mg daily) or placebo group (500 mg of maltodextrin daily). 76 subjects were successfully randomised, with 38 in the C. striatus group and 35 in the placebo group. There were no significant differences in postoperative pain (p = 0.814) and WES (p = 0.160) between the C. striatus and placebo groups. However, VAS and PSS in the C. striatus group were significantly better compared with the placebo group (p = 0.014 and p < 0.001, resp.). The safety profiles showed no significant differences between the groups. In conclusion, six-week supplementation of 500 mg of C. striatus extract showed marked differences in wound cosmetic appearance and patient's satisfaction and is safe for human consumption.

The Effect of Labisia pumila var. alata on Postmenopausal Women: A Pilot Study.

This is a randomized, double-blind, placebo-controlled study comparing the effects of a water extract of Labisia pumila var. alata at 280 mg/day with placebo, given for 6 months in postmenopausal Malay women. There were 29 patients treated with Labisia pumila and 34 patients in the placebo group. Menopausal symptoms were assessed at baseline and at 6 months. The blood pressure, body mass index, waist circumference, fasting blood sugar, lipid profile, and hormonal profile (follicle stimulating hormone/luteinizing hormone/estradiol) were measured during visits every two months. ANCOVA model analysis showed significantly lower triglycerides levels in LP subjects at 6 months after treatment as compared to placebo (1.4 versus 1.9 mmol/L; adj. mean difference 0.5, 95% CI: 0.02, 0.89 after adjusted for the baseline values, age, BMI, and duration of menopause placebo). Other parameters in both groups did not differ significantly. In conclusion, daily intake of Labisia pumila at 280 mg/day for six months was found to provide benefit in reducing the triglyceride (TG) values.